Treating the active phase of the disease without allowing the treatment itself to cause long-term damage to the patient is the major challenge for doctors. As a result of this physicians are now less hesitant to use immunosuppressive drugs such azathioprine (Imuran) or cyclophosphamide (Cytoxan). Treatment for active systemic lupus erythematosus, on the other hand, depends on the organ systems involved and disease severity; this includes a combination of drugs.
Nonsteroidal antiinflammatory drugs are used to reduce inflammation and pain in muscles, joints, and other tissues. These may include aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and sulindac (Clinoril). The most common side effects are stomach upset, abdominal pain, ulcers, and even ulcer bleeding. Corticosteroids are more potent than NSAIDs in reducing inflammation and restoring function in active disease, specially when internal organs are involved. The disadvantage of this is when it is given in high doses over prolonged periods. Physicians should monitor the activity of the disease in order to use the lowest doses that are safe. Side effects include weight gain, thinning of the bones and skin, infection, diabetes, facial puffiness, cataracts, and death (necrosis) of large joints. Another drug used in the treatment of SLE is Hydroxychloroquine (Plaquenil), an antimalarial medication. It is effective for SLE patients with...
Side effects include diarrhea, upset stomach, and eye pigment changes. Eye pigment changes are rare, but require monitoring by an ophthalmologist (eye specialist) during treatment with Plaquenil.
Plasmapheresis is sometimes used to remove antibodies and other immune substances from the blood to suppress immunity for patients with serious brain or kidney disease. Some patients with SLE can develop very low platelet levels. This gives the risk of excessive and spontaneous bleeding. Therefore, surgical removal of the spleen is sometimes performed to improve platelet levels. Other treatments include plasmapheresis and the use of male hormones. Plasmapheresis has also been used to remove proteins (cryoglobulins) that can lead to vasculitis. End stage kidney damage from SLE requires dialysis and/or a kidney transplant.
Bibliography
Systemic Lupus Erythematosus,
Bertram Greenspun, DO, February 9, 2007
Familial Systemic Lupus Erythematosus: The Role of Genetic and Environmental Factors, G.E. Eroglu and P.F. Kohler, Annals of the Rheumatic Diseases 2002;61:29-31
Treatment of Systemic Lupus Erythematosus: An Update, Michelle Petri, M.D., M.P.H., American Family Physicians, June 1998
Systemic Lupus Erythematosus (SLE or Lupus),
William C. Shiel Jr., MD, FACP, FACR, September 2006
